FORM
• For Domestic applicants, please fill up FORM A1 (Page 1 & 2) and
FORM 12 (Page 5 & 6)
• For International applicants, please fill up FORM A1, A2 and
FORM 12 (Page 1 to 6)
•Incomplete application forms submitted without all supporting documents
will delay the evaluation process.
A1
APPLICATION FORM
PROGRAMME __________________________________________________________________________________
(Example: Bachelor of Arts in Business Management)
STUDENT NUMBER : ____________________________
PART-TIME / FULL TIME
(Please Circle One)
INTAKE TERM
:
TERM:
________ YEAR: __________
MODE OF STUDY : 2 Modules Per Term / 3 Modules Per Term
1. PERSONAL DETAILS
NRIC/FIN No:
Title: Mr / Mrs / Ms / Dr Full Name:
(As it appears in your NRIC / Passport. Please underline surname / family name)
Singapore Address:
Postal Code:
Home Country Address:
(for International student)
Home contact no:
Mobile phone no:
Province/State:
Country of Birth:
Date of Birth:
Marital Status:
E-mail:
Single
Married
Gender:
Male
Female
(dd/mm/yy)
Type of Document Held: ________________________________ (eg: Passport)
Serial No. of Document: ________________________________
Issue Date: ________________________
(eg: Passport No.) Expiry Date: ________________________
(dd/mm/yyyy)
Country of Issue: __________________________________________ Place of Issue :
Nationality:
Singaporean
Race:
Chinese
Others (specify):
Malay
Indian
Others (specify):
Religion:
For non-Singaporean Citizen only:
Permanent Resident
Employment Pass / Work Permit / QP
Student Pass
Dependant Pass (Issued by: _______________________ )
State the expiry date of your pass:
National Service Status:
Pre-Enlistee
Not Applicable
(dd/mm/yy)
NSF / NSmen / Completed
2. STUDENT’S EDUCATIONAL BACKGROUND
NAME OF SCHOOL
COUNTRY/
PROVINCE
EDUCATIONAL
CERTIFICATE
NO
PERIOD OF STUDY
LANGUAGE
Page 1 of 6
FROM
TO
(dd/mm/yy)
(dd/mm/yy)
HIGHEST EDUCATIONAL
QUALIFICATION
3. STUDENT’S RECENT EMPLOYMENT HISTORY
NAME OF COMPANIES
PERIOD OF WORK
COUNTRY
FROM
(dd/mm/yy)
POSITION HELD
TO
(dd/mm/yy)
4. STUDENT’S INFORMATION
Auston Location and Facilities,
The course duration and assessment schedules;
Auston Application and Course Requirements and Criteria;
The promotion criteria;
The course I am applying for; The award I am applying for (degree / diploma);
The General Laws of Singapore and Employment Rules;
The Fees of the course; How my fees will be protected;
Visa and student’s pass application requirements and procedures;
The student contract;
Personal and Medical Insurance;
The Refund policy and The Transfer and Withdrawal policy;
Advice on accommodation and the cost of living;
The Student Support services;
General healthcare services in Singapore
The Modules in my Course; The module outlines;
Form 12 of Private Education Act
I may approach the Council for Private Education for further queries at
www.cpe.gov.sg
I have been informed of all the above details:
………………………………………
Signature of Student / Date
I am a
Direct Applicant (Name of Course Consultant: _______________________________________)
___
Referral by an Authorised Overseas Representative
(Name of Representative Company: _________________________________________)
5. STUDENT’S DECLARATION
I certify that all information given by me in this application form is true and correct. I understand that any
misrepresentation or omission of information may make me ineligible for admission or subject to dismissal. I understand
that if I am unable to provide the documents to support the information provided, Auston Institute of Management has the
right to withdraw the offer without any refund of application or course fees paid. I also authorise any investigation
conducted upon the information provided for the purposes of verification.
I have read and understood all the information in the brochure / prospectus / Auston student guide.
Si gnature of Student
Date
Page 2 of 6
FORM
A2
ITEM 6, 7 AND 8 - FOR INTERNATIONAL APPLICANTS ONLY
6. STUDENT’S NATURAL PARENTS/STEP PARENTS/SPOUSE/SIBLINGS
FULL NAME
RELATIONSHIP
DATE OF
BIRTH
NATIONALITY
(dd/mm/yy)
OCCUPATION
RESIDENTIAL STATUS IN
SINGAPORE
(PR/WP/DP/CITIZEN)*
7. STUDENT’S FINANCIAL SUPPORT DETAILS (Only for VISA-Required Country)
AVERAGE MONTHLY INCOME FOR THE PAST 6 MONTHS
(Please write in Singapore Dollars)
STUDENT
SPOUSE
FATHER
MOTHER
OTHER FINANCIAL SUPPORT FROM IMMEDIATE FAMILY MEMBERS:
Page 3 of 6
CURRENT SAVINGS
(Please write in Singapore Dollars)
8. INTERNATIONAL STUDENTS DECLARATION
HAVE YOU EVER:
VISITED SINGAPORE?
BEEN REFUSED ENTRY INTO OR DEPORTED FROM ANY COUNTRY?
BEEN CONVICTED IN A COURT OF LAW IN ANY COUNTRY?
BEEN PROHIBITIED FROM ENTERING SINGAPORE?
ENTERED SINGAPORE USING A DIFFERENT PASSPORT OR NAME?
HELD A SINGAPORE STUDENT PASS BEFORE?
YES
YES
YES
YES
YES
YES
/
/
/
/
/
/
*If any of the answer is “YES”, please furnish details on a separate sheet of paper
i.
I hereby declare that all particular and information furnished above are true and correct.
ii.
I undertake not to study in Singapore without a Student’s Pass.
iii.
I undertake not to misuse controlled drugs or take part in any political or other activities during my stay
in Singapore which would make me an undesirable or prohibited immigrant under Immigration Act.
iv.
I undertake to comply with provisions of the Immigration Act and any regulations make thereunder or any
statutory modification or re-enactment thereof for the time being in force in Singapore.
v.
I undertake not to involve in any criminal offences in Singapore.
vi.
I undertake not in indulge in any activities which are inconsistent with purpose for which the immigration
passes have been issued.
vii. I undertake not to miss any lesson and always maintain a minimum of 90% of attendance.
viii. I further undertake not be engaged in any form of employment or in any business, profession or occupation
in Singapore whether paid or unpaid, without the consent in writing of Controller of Immigration.
ix.
I am aware that overstaying or working illegally in Singapore is a serious offence and on conviction, the
penalties may include mandatory imprisonment or caning.
x.
I understand that if the Controller of Immigration is satisfied that I or any member of my family breaches
this undertaking or becomes an undesirable or prohibited immigrant, he will cancel my immigration pass
and passes of the members of my family, and we may be required to leave Singapore within 24 hours of
such cancellation.
xi.
I give my consent for your department to obtain and verify information or with any source, as you deem
appropriate for the assessment of my application for immigration facilities.
…………………………………
Signature of Student
Date
Page 4 of 6
NO
NO
NO
NO
NO
NO
Regulation 25(5)(b)
FORM 12
PRIVATE EDUCATION
ACT (No. 21 of 2009)
PRIVATE EDUCATION REGULATIONS
ADVISORY NOTE TO STUDENTS
This note is for a prospective student.
You are strongly encouraged to thoroughly research on the private education
institution (PEI) conducting the course before signing up for any course. You should
consider, for example, the reputation of the PEI, the teacher-student ratio of its classes,
the qualifications of the teaching staff, and the course materials provided by the PEI.
By signing and returning the Student Contract (the “Contract”), you agree to the terms
and conditions which will bind you and the PEI, if you accept the PEI’s offer of a place in
a course of study offered or provided by the PEI.
You should ask the PEI to allow you to read a copy of the Contract (with all blanks filled
in and options selected) in both English and the official language of your home country, if
necessary. For your own protection, you should review all the PEI’s policies, and check
carefully that you agree to all the terms of the Contract, including the details relating to
each of the following sections, before signing the Contract:
a.
The duration of the course, including holidays and examination
schedules, and contact hours by days and week;
b.
The total fees payable, including course fees and other related costs;
c.
Dates when respective payments are due;
d.
The refund policy in the event of voluntary withdrawal (by you) or
enforced dismissal from the course or programme (by PEI);
e.
The Fee Protection Scheme you are subscribed to and its coverage;
f.
The dispute resolution methods available; and
g.
Information about the PEI’s policies on academic and disciplinary matters.
h.
The degree or diploma or qualification which will be awarded to you
upon successful completion of the course.
Page 5 of 6
If you have any doubt about the contents of the Contract, or if the terms are different from what
the agent or the PEI have informed you previously, or advertised, you should always seek
advice and/or clarifications before signing the Contract.
This portion below is to be completed by the signatory of the Student Contract, i.e. either the
student, or if the student is below the age of 18, his parent or guardian.
I, ____________________________________, NRIC/Passport number
_________________, (name of student/parent/guardian) (NRIC/passport no.)
have read and understood this advisory note before signing the Student Contract for
myself/my ward** (__________________________________(NRIC/passport)_____________) (name of ward)
Auston Institute of Management Pte Ltd
with ___________________________________________________________________.
(name of PEI)
_____________________________________
(Signature of student or parent / guardian)
Date : ___________________________
*Please delete whichever is inapplicable.
Page 6 of 6
INSTRUCTIONS TO ALL APPLICANTS
PLEASE READ ALL INSTRUCTIONS ON THIS PAGE.
STEP 1: Fill Application Form
STEP 2 : Make Payment
STEP 3 : Evaluation
Complete this application form and
email it to [email protected]
or mail the physical copy to
Send payment of $107.00 for SC/ PR
and WP holders; or $481.75 for
International Students
Auston will now evaluate your
application form. Processing time
should normally take 3 working days.
50 Ophir Road, #02-00
Church of Our Lady of Lourdes
Singapore 188690
Processing will commence after step 2.
Auston Institute of Management Pte Ltd
50 Ophir Road, #02-00
Church of Our Lady of Lourdes
Singapore 188690
Once completed, a member of our staff
will contact you.
Thank you for applying to Auston.
CONFIDENTIALITY POLICY Auston Institute of Management Pte Ltd offers confidentiality. Any sensitive information given will not
be passed on except in very rare circumstances where this is necessary to protect a vulnerable person from harm, or to comply with
the law. In such circumstances, the information will only be passed on as permitted in this policy. Where ever possi ble and
appropriate the person will be informed that this action has been taken.
PERSONAL DATA PROTECTION ACT (PDPA) I hereby agree and consent that Auston Institute of Management Pte Ltd may
collect, use, disclose and process my personal information provided by me or possessed by Auston Institute of Management Pte
Ltd, for one or more of the purposes as stated in confidentiality policy, which includes but is not limited to the following:
(a) Processing my application through university partner;
(b) Sending me marketing, advertising and promotional information about other products/ services that Auston Institute
of Management Pte Ltd may be offering, and which Auston Institute of Management Pte Ltd believes may be of interest
or benefit to me, by way of e-mail or telephone number(s) in the form of voice call or SMS (text message).
Opt Out for subclause (b)
Please be informed that you have the right to opt out of receiving marketing messages. Kindly send an e-mail to [email protected] with your full name,
NRIC number, telephone number(s) and e-mail to opt out from subclause (b).
PAYMENT METHODS
All fee payment can be made via the following modes:
•
•
•
•
NETS
Cheque (Crossed and made payable to Auston Institute of Management Pte Ltd)
Bank draft
Internet Banking Transfer
Note:
Any cheques that are presented for payment of fees and dishonoured by the Bank will incur an administrative fee of S$20.00.
International Students are recommended to pay using telegraph transfer. All course tuition fees for the school “Auston
Institute of Management Pte Ltd” should be remitted by telegraphic transfer to the following bank account in Singapore
Dollars:
Account Name
Account Number
Bank Name
Bank Address
Bank Swift Code
Auston Institute of Management Pte Ltd
372-300-460-6
United Overseas Bank Limited,
1 Coleman Street #01-14 & B1-19, The Adelphi, Singapore 179803
UOVBSGSG
All banking charges, if any, are to be borne by the sender. Students are required to quote the student’s name and course
details in the remittance document as the remittance message for verification.
ADDRESS 50 OPHIR ROAD, #02-00 SINGAPORE 188690 TELEPHONE (65) 6334 5900 EMAIL [email protected]
REC/001/04
Auston Institute of Management Pte Ltd Co Reg Nos: 200510122R
24 November 2015